Just last November IRIN/PlusNews published a list of countries who are “Falling foul of the Fund.” What distinguishes this ‘club’ of 10 countries on the list is poor performance that resulted in cancellation or suspension of their Global Fund grants.Â For example, in Pakistan the, “Fund discontinued support for (its) malaria projects because of weak project implementation, slow procurement of health products, poor data quality, and slow spending of project funds.” Uganda was one of the worst case scenarios according to PlusNews:
In 2005, the Global Fund temporarily suspended all five of its grants after a review by PricewaterhouseCoopers of one of the grants revealed evidence of “serious mismanagement” by the Project Management Unit in the Ministry of Health. The grants were worth a total of $201 million over two years, of which $45.4 million had already been disbursed. The health minister and his two deputies lost their positions and are on trial with several other government officials for charges relating to the misuse of Global Fund money.
Now there are reports out of Lusaka, Zambia that the Ugandan ‘model’ may be repeated, but only to the tune of $2million. “The governments of the Netherlands and Sweden announced they had suspended aid after a whistleblower alerted Zambia’s Anti-Corruption Commission [ACC] to the embezzlement of over US$2 million from the health ministry by top government officials.”
In Zambia, like many malaria-endemic countries, “most of the national health budget is donor-funded.” The report highlights the suffering of people affected by the HIV, malaria and TB when the misbehavior of public officials threatens the funds that keep those suffering alive.
While this experience may feed into the recent debate on the value or danger of foreign aid, the reality is that the massive efforts to control major diseases requires support from the global community – support that recognizes our common humanity.Â A positive example is Rwanda where the national health account shows that in 2006 donor support accountred for 53% of total health expenditure.Â Rwanda has become the poster child for the benefits to malaria control and eventual elimination, but just a slight step to the dark side, as it were, could jeopardize all the gains in a minute.
Clearly if we want to eliminate malaria the solution is not to withdraw or withhold funds from endemic countries. The question is do we have accountable mechanisms for using the funds? Do we put all our funds in one basket, or do we spread them among public, private and civil society sectors?Â Without viable answers to these questions, malaria will never be eliminated.